High Prevalence of Enterotoxigenic Escherichia coli Strains in Hospitalized Diarrheal Patients: A Preliminary Study from a Cholera-Endemic Area, India (2022)

Hemant Khuntia¹Prabir Manna²Deepak Kumar Barik²Subhojeet Biswas²Prasanta Kumar Bramha¹Sanghamitra Pati²Manoranjan Ranjit²Madhusmita Bal²Anna Salomi Kerketta^2*

• ¹Siksha O Anusandhan University, Bhubaneswar, Odisha, India
• ²Regional Medical Research Center (ICMR), Bhubaneswar, India

Enterotoxigenic Escherichia coli (ETEC), which produce heat-stable enterotoxin (ST) and/or heat-labile enterotoxin (LT), continues to be a leading cause of diarrhea in young children and travelers in developing countries. Monitoring the prevalence of ETEC in acute diarrhea cases is essential for early warning and prevention efforts. This study aimed to determine the prevalence of ETEC in a cholera-endemic area, Puri, India, between May and November 2022. ETEC was identified as the main diarrheal pathogen, while no Vibrio cholerae was isolated. Analysis of 256 rectal swab samples from hospitalized diarrhea patients revealed ETEC (20.3%) as the dominant pathogen, followed by enteroaggregative E. coli (EAEC) (6.2%) and enteropathogenic E. coli (EPEC) (2.3%).ETEC was significantly more common in children under 2 years old (p<0.00001), highlighting a peak in infancy. However, the overall correlation with age was very weak (R = -0.013), suggesting that ETEC prevalence does not consistently vary with age across all patients. Clinical symptoms such as watery stool, vomiting, abdominal pain, and dehydration were observed in ETEC-infected individuals, with dehydration significantly associated with adults (p < 0.05). ETEC strains were susceptible to streptomycin, chloramphenicol, gentamicin, and amikacin. The emergence of ETEC as the dominant diarrheal pathogen in a cholera-endemic region is a public health concern for both children and adults, warranting continued epidemiological surveillance. OR = Odds Ratio (comparing 0-23 months to ≥15 years).